Aaron Trinidade

Long-Term Hearing Results After Ossiculoplasty

OBJECTIVESnTo determine if the OOPS index is predictive of long-term hearing results after ossiculoplasty.nnnSTUDY DESIGNnCase series with retrospective chart review.nnnSETTINGnTertiary care otology practice.nnnPATIENTSnAdult and pediatric patients (3-88 years of age).nnnINTERVENTIONSnOssiculoplasty with cartilage tympanoplasty, with or without mastoidectomy.nnnOUTCOME MEASURESnPrimary outcome measures included short-term hearing results (pure-tone average air-bone gap [PTA-ABG] measured between 60 days and 1 year after surgery), long-term hearing results (PTA-ABG measured ≥5 years after surgery), and the rate of successful ABG closure to ≤20u200adB. Secondary measures included the need for revision surgery, delayed tympanic membrane graft failure, worsening conductive hearing loss (after an initially satisfactory hearing result), and recurrence of cholesteatoma.nnnRESULTSnThere was no significant difference between adults and children for short-term hearing results (average post-op PTA-ABG was 18.9u200adB vs. 19.8u200adB, respectively; pu200a=u200a0.544), long-term hearing results (average final PTA-ABG was 19.3u200adB vs. 19.4u200adB, respectively; pu200a=u200a0.922), or rate of ABG closure to less than 20u200adB (63.1% vs. 58.0%, pu200a=u200a0.282). Spearmans rank-order correlation (ρ) identified a strong positive correlation between OOPS index score and average post-operative PTA-ABG (ρu200a=u200a0.983; pu200a<u200a0.001; 2-tailed), as well as average long-term PTA-ABG (ρu200a=u200a0.950, pu200a<u200a0.001; 2-tailed).nnnCONCLUSIONSnThe OOPS index makes it possible to accurately prognosticate hearing outcomes in adult and pediatric patients undergoing ossiculoplasty in both the short term and the long term.

Simultaneous versus sequential bilateral cochlear implants in adults: Cost analysis in a US setting

From a purely surgical efficiency point of view, simultaneous cochlear implantation (SimCI) is more cost‐effective than sequential cochlear implantation (SeqCI) when total direct costs are considered (implant and hospital costs). However, in a setting where only SeqCI is practiced and a proportion of initially unilaterally implanted patients do not progress to a second implant, this may not be the case, especially when audiological costs are factored in. We present a cost analysis of such a scenario as would occur in our institution.

Therapeutic Mastoidectomy in the Management of Noncholesteatomatous Chronic Otitis Media: Literature Review and Cost Analysis.

Objective Despite evidence that therapeutic mastoidectomy does not improve outcomes in noncholesteatomatous chronic otitis media, it remains widely performed. An up-to-date systematic review is undertaken and conclusions drawn regarding the best evidence-based practice of its management. Data Sources PubMed, Google Scholar, Medline Embase, Cochrane, and Web of Science. Review Method A combination of the following words was used: chronic otitis media, chronic suppurative otitis media, COM, CSOM, mastoidectomy, tympanoplasty, atelectasis, retraction, tympanic perforation, and therapeutic. Results From 1742 studies, 7 were selected for full analysis with respect to the benefit of mastoidectomy in the management of active and inactive mucosal chronic otitis media. Most were retrospective studies, with 1 prospective randomized controlled trial available. Overall, there was no evidence to support routine mastoidectomy in conjunction with tympanoplasty in chronic otitis media. For ears with sclerotic mastoids, the evidence suggested that there may be some benefit as a staged procedure. Two studies were analyzed for the benefit of mastoidectomy in addition to tympanoplasty for the management of the atelectatic ear (inactive squamous chronic otitis media). The conclusion was also that mastoidectomy added no benefit. Conclusions Examination of the available literature supports the notion that therapeutic mastoidectomy does not lend any additional benefit to the management of noncholesteatomatous chronic otitis media. This has implications for patient care, both clinically and financially. Further research, ideally in the form of a prospective, multi-institutional, geographically wide, ethnically diverse, randomized controlled trial, is needed to further support this notion.

Long-term Complications and Surgical Failures After Ossiculoplasty

OBJECTIVEnTo study long-term complications after ossiculoplasty.nnnSTUDY DESIGNnCase series with chart review.nnnSETTINGnTertiary care referral center otology practice.nnnPATIENTSnOne hundred ninety-five patients (18-88 yr of age) undergoing ossiculoplasty with tympanoplasty or tympanomastoidectomy using cartilage tympanic membrane grafts, retrograde mastoidectomy with canal wall reconstruction, or mastoid obliteration techniques between July 1998 and July 2012. The studied patients all had at least 3 years of clinical follow-up.nnnOUTCOME MEASURESnIncidence of long-term complications, including need for revision surgery, need for secondary ventilation tube placement, recurrence of conductive hearing loss (and related etiologies), recurrent cholesteatoma, and delayed graft failure (recurrent tympanic membrane perforation).nnnRESULTSnLong-term complications were observed in 10.3% (20/195) of patients. 8.2% (16/195) required revision surgery, 10.2% (17/195) required secondary ventilation tube placement, 3.6% (7/195) experienced recurrence of conductive hearing loss, 4.1% (8/195) had delayed failure of tympanic membrane graft, and 1.5% (3/195) had recurrence of cholesteatoma. Recurrence of conductive hearing loss was caused by the displacement of prosthesis in 3 of 7 patients and extensive scar tissue formation without prosthesis displacement in 4 of 7 patients. Seventy-two percent obtained a postoperative pure-tone average - air-bone gap u200a<u200a20u200adB. Forty-eight percent (93/195) obtained a hearing result worse than expected based on the ossiculoplasty outcome parameter staging index.nnnCONCLUSIONnLong-term complications are a significant consideration in all the patients undergoing ossiculoplasty. Our data suggest that tobacco smoking, Eustachian tube dysfunction, and an unexpectedly poor hearing result on the first postoperative audiogram are all important risk factors for the development of significant complications.

Long-term Outcomes After Secondary Mastoid Obliteration.

Objectives: To assess long-term outcomes after secondary mastoid obliteration. Study Design: Case series with chart review. Setting: Tertiary care center. Patients: Adult patients (20–80 yr of age) undergoing secondary mastoid obliteration. Outcome Measures: Hearing results (improvement in pure-tone average air-bone gap [PTA-ABG] from baseline) at the time of postoperative audiometry and at least 5 years after surgery, anatomic outcomes (rate of successful tympanic membrane graft healing), and the incidences of observed complications. Results: An average improvement in PTA-ABG by 16.9u200adB (pu200a=u200a1.8u200a×u200a10−9) was noted. Postoperatively, the PTA-ABG was successfully closed to ⩽20u200adB in 39.5% (17/43) of patients. The average final PTA-ABG (obtained at least 5 years after surgery) was 25.3u200adB, which was also a significant improvement over the preoperative baseline PTA-ABG (p <<< 0.01). Significant complications were observed in 14.0% (6/43) of patients, with 9.3% (4/43) requiring a subsequent surgery. Although 69.8% (30/43) of patients experienced otorrhea preoperatively, otorrhea was only observed in 4.7% (2/43) at any point in time postoperatively. Conclusion: Secondary mastoid obliteration with reconstruction of a more natural posterior canal wall, cartilage tympanoplasty, and ossicular chain reconstruction is a hybrid technique that allows for creation of a safe, dry ear with significant, long-term improvement in hearing and functional outcomes in patients with unstable mastoid cavities.

Does cochlear implant brand influence patient satisfaction? A survey of 102 cochlear implant users

1. Wexler D, Braverman I, Amar M. Histology of the nasal septal swell body (septal turbinate). Otolaryngol Head Neck Surg. 2006;134:596600. 2. Setlur J, Goyal P. Relationship between septal body size and septal deviation. Am J Rhinol Allergy. 2011;25:397-400. 3. Elwany S, Salam S, Soliman A, et al. The septal body revisited. J Laryngol Otol. 2009;123:303-308. 4. Costa DJ, Sanford T, Janney C, et al. Radiographic and anatomic characterization of the nasal septal swell body. Arch Otolaryngol Head Neck Surg. 2010;136:1107-1110. 5. Cole P. The four components of the nasal valve. Am J Rhinol. 2003;17:107-110. 6. Gelera JE, Ojar D, Lim JH, et al. Radiographic changes of the nasal septal body among patients with sinonasal diseases. Clin Exp Otorhinolaryngol. 2017;10:338-343. 7. Wotman M, Kacker A. Should otolaryngologists pay more attention to nasal swell bodies? Laryngoscope. 2015;125:1759-1760. 8. Yu MS, Kim JY, Kim BH, et al. Feasibility of septal body volume reduction for patients with nasal obstruction. Laryngoscope. 2015;125:1523-1528. 9. San T, Muluk NB, Saylisoy S, et al. Nasal septal body and inferior turbinate sizes differ in subjects grouped by sex and age. Rhinology. 2014;52:231-237. 10. Berger G, Gass S, Ophir D. The histopathology of the hypertrophic inferior turbinate. Arch Otolaryngol Head Neck Surg. 2006;132:588594.

The Influence of Intraoperative Testing on Surgical Decision-making During Cochlear Implantation

OBJECTIVEnTo review our use of intraoperative testing during cochlear implantation (CI) and determine its impact on surgical decision-making.nnnSTUDY DESIGNnRetrospective chart review.nnnSETTINGnTertiary referral center.nnnPATIENTSnA total of 197 children and adults who underwent a total of 266 primary and/or revision CI by a single surgeon from 2010 to 2015.nnnINTERVENTIONnIntraoperative electrophysiologic monitoring including evoked compound action potentials and electrical impedances.nnnMAIN OUTCOME MEASURESnWhether surgical management was changed based on intraoperative testing.nnnRESULTSnIn only 2 of 266 patients (0.8%), the back-up device was used due to findings on intraoperative testing. In three patients (1.1%), X-ray was performed intraoperatively to confirm intracochlear electrode placement, which was found to be normal in all patients.nnnCONCLUSIONnOur data suggest that with respect to CI in children and adults in straightforward cases (e.g., normal anatomy, nondifficult insertion, etc.), routine intraoperative evoked compound action potentials, impedances, and imaging rarely influence surgical decision-making in our clinic and may have limited usefulness in these patients. The implications of this are discussed and a review of the literature is presented.

The vertical juxtaposition junction (VJJ) flap ‐ a useful flap in mastoid obliteration surgery: our long‐term experience in twenty patients

• Laryngeal involvement is a marker of severe disease in mucous membrane pemphigoid (MMP). • MMP should be considered as a differential diagnosis in patients with atypical laryngeal pathology. • Systemic immunosuppression is the mainstay of management. • Airway obstruction may be life-threatening and require tracheostomy in severe cases. • The proposed scale can indicate the severity of the disease process in the larynx. Conflict of interest

Prevalence of Allergens in a British Farming Population

were Submucous diathermy (25 patients), Turbinoplasty (85 patients), and Turbinoplasty with posterior turbinectomy (105 patients). The patients were followed up regularly every week for three weeks, then every three months for at least two years. Doctor assessment scale and patients’ assessment score were filled in during every visit until the end of the follow-up period and any remarks were recorded and dealt with accordingly. RESULTS: Nasal pack for one day was a standard protocol following surgery. Patients in group A (Submucous diathermy) were the last patients to record a better quality of breathing following surgery; 18 patients (72%) recording a better breathing 8 days after surgery compared to 70 patients (82.4%) in group B (Turbinoplasty) and 96 patients (91.4%) in group C (Turbinoplasty with Posterior Turbinectomy). Tendency for postoperative nasal bleeding was not significantly higher in any of the studied group (p-value 0.1). The overall patient satisfaction was significantly higher in group C than group B which was also significantly higher than group A (p-value 0.05). Doctor’s satisfaction came in accordance with patients’ satisfaction. CONCLUSION: Posterior turbinectomy with turbinoplasty gives a better surgical outcome and better patient satisfaction in cases of inferior turbinate hypertrophy than submucous diathermy or turbinoplasty alone.